Aortoenteric fistula: diagnosis and management.

During the last ten years, 14 patients with proven aortoenteric fistulas were admitted to the Greenville Hospital System, a community system of 1200 beds in four units serving a county of 250,000 residents. The experience obtained is tabulated, and illustrative case reports are used to emphasize the diagnostic and treatment problems inherent in this group of patients. It is obvious that two major manifestations result when intra-abdomial vascular prostheses communicate with some portion of the gastrointestinal tract. The most common manifestation of aortenenteric fistual is massive GI hemorrhage, usually preceded by an earlier, less consequential bleeding episode called a "herald bleed." If the small bowel, other than the duodenum or colon, is involved, then chronic bleeding and sepsis are most characteristic. The problems of diagnosis and management are discussed.